Physician trust and depression influence adherence to factor replacement: a single‐centre cross‐sectional study

Abstract

Introduction Poor adherence to factor replacement therapy amongst patients with hemophilia can lead to joint bleeding and eventual disability. Aim The aim of this study is to determine patient-related characteristics associated with adherence to factor replacement in adults with hemophilia. Methods Adults with hemophilia were recruited to participate in this cross-sectional study. Adherence was measured using either the Validated Hemophilia Regimen Treatment Adherence Scale (VERITAS)-Pro or the VERITAS-PRN questionnaire. Simple and multiple regression analyses that controlled for confounding were performed to determine the association between patient-related characteristics and adherence to factor replacement therapy. Results Of the 99 subjects enrolled, all were men; 91% had hemophilia A and 78% had severe disease. Age ranged from 18 to 62 years. Most (95%) had functional health literacy; but only 23% were numerate. Mean adherence scores were 45.6 (SD 18) and 51.0 (SD 15) for those on a prophylactic and those on an episodic regimen, respectively, with a lower score indicating better adherence. On multivariable analysis, being on any chronic medication, longer duration followed at our hemophilia treatment center, higher physician trust, and better quality of life were associated with higher adherence. A history of depression was associated with lower adherence. Conclusion Two potentially modifiable characteristics, physician trust and depression, were identified as motivator and barrier to adherence to factor replacement therapy. Promoting a high level of trust between the patient and the healthcare team as well as identifying and treating depression may impact adherence to factor replacement therapy and accordingly reduce joint destruction.

Emotional distress in haemophilia: Factors associated with the presence of anxiety and depression symptoms among adults

“…In addition, the use of standardized scales for anxiety and depression screening was also a distinguishable feature of this investigation. Most studies in haemophilia field report anxiety/depression levels based on mental health subscales of health-related quality of life questionnaires, 29-32 on self-reports of presence of anxiety/depression, 9,33 or on unstandardized questions developed for the purpose of specific studies. [34][35][36] The results of this investigation advance the knowledge on factors associated with anxiety and depression among PWH, drawing relevant conclusions to inform interventions aiming to promote well-being among these patients.…”

“…This is particularly relevant considering that medical treatments alone may not be sufficient to address some of the challenges faced by PWH . Moreover, high levels of distress have a detrimental impact on adherence to factor replacement therapy and disease management, potentially affecting haemophilia‐related health outcomes . Given these associations, and regardless of whether emotional distress is a cause or a consequence of disease and treatment issues, a promising strategy for improving haemophilia outcomes would therefore be the effective management of emotional distress experienced by patients.…”

“…6 Moreover, high levels of distress have a detrimental impact on adherence to factor replacement therapy and disease management, potentially affecting haemophilia-related health outcomes. 8,9 Given these associations, and regardless of whether emotional distress is a cause or a consequence of disease and treatment issues, a promising strategy for improving haemophilia outcomes would therefore be the effective management of emotional distress experienced by patients. A thorough psychosocial assessment, including an appropriate anxiety and depression screening, is therefore warranted in haemophilia care, towards a more systemic approach and integrated care.…”

Measuring therapeutic relationship in the care of patients with haemophilia: A scoping review

“…At present, there is an emphasis in haemophilia research on understanding the factors that influence patient's degree of adherence to treatment, which is important because patient adherence to treatment is linked with positive outcomes such as reduced pain and improved joint health . Further, preliminary research suggests significant associations between patients' degree of adherence to factor replacement therapy and certain dimensions of therapeutic relationship . Specifically, patients reporting a higher degree of trust in their haemophilia physician have higher rates of adherence to treatment .…”

“…Further, preliminary research suggests significant associations between patients' degree of adherence to factor replacement therapy and certain dimensions of therapeutic relationship . Specifically, patients reporting a higher degree of trust in their haemophilia physician have higher rates of adherence to treatment . Similarly, a good relationship with a haemophilia health‐care provider has been positively correlated with adherence levels …”